Stop HIV meds or simply continue?

Jun 5, 2004

I am a person co-infected with HIV/HCV. I tested positive for HIV back in 1996 when my viral load was high and my T cell count had dropped to close to 300. My doctor then put me on my first regimen which consisted of Invirase (later updated to Fortovase), Zerit , and Epivir. I did very well with this combo except that I started developing signs of lipodystrophy so on August 2002 my second doctor switched me to Viramune, Epivir, Viread. I now have a new but experienced doctor who's suggesting I go off my meds. because my T cells have remained between 600-800 since I first started treatment. He also says there could be some benefit to my liver due to the fact that I've been on treatment for Hep C for the second time around without greeat results. I had a liver biopsy on January of 2003 and it showed stage 2 fribrosis and stage 2 inflamation. My question is as follows: Do you really think I should follow my doctor's suggestions and stop right now? I have never been resistant to any HIV drug so far because I've always made sure to take my meds. as indicated or at least very close. Please help!

Response from Dr. Pierone

It is reasonable to stop your HIV medications for a while. We worry about long-term liver toxicity of antiretroviral medications and this is why some clinicians suggest stopping. The essential question is whether HIV infection must be treated continuously for life or if intermittent therapy may suffice. As you might imagine, the pharmaceutical companies have not been too keen to test the latter hypothesis and are quite content with the status quo. Nonetheless, stopping studies have shown the this strategy appears to be generally safe for people with high CD4 counts as long as their counts were not very low before they started treatment. If you do stop be prepared to see a fairly rapid initial decline in CD4 cells which will then typically stabilize and decline more slowly. There is nothing wrong with deciding to continue treatment and veto the suggestions of your doctor. It may turn out that continuous therapy is the best long-term course of action, especially for people (like you) that have a demonstrated ability to adhere to therapy and not develop drug resistance.

If you are unsure of the best course you might consider the SMART study, this large study compares intermittent therapy with continuous treatment. Best of luck!

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